849: The association between engagement in a perinatal collaborative care program and breastfeeding

Abstract

Perinatal collaborative care is a health systems approach to deliver mental health care within the obstetric setting. While perinatal collaborative care has been associated with improvements in mental health outcomes in randomized trials, not all referred women engage in the care provided. Untreated antenatal mental health disorders are associated with lack of initiation and early discontinuation of breastfeeding. Our objective was to examine whether engagement of women with a mental illness referred antenatally to a perinatal collaborative care program was associated with differences in breastfeeding intention and continuation, and whether any observed association was mediated by changes in depressive symptoms. This retrospective cohort study included all women who were referred antenatally by their obstetrician to a perinatal collaborative care program and who delivered viable infants between January 2017 and June 2018. Women were dichotomized by whether they engaged in collaborative care services, defined as participation in either therapy and/or medication management services. Breastfeeding intention (endorsed at delivery) and continuation at the postpartum visit were compared between women who did and did not engage in collaborative care by using bivariable and multivariable analyses. Mediation analyses were performed to determine if any observed associations were mediated by improvements or remission in depressive symptoms. Of the 340 eligible women referred to the perinatal collaborative care program, 264 (75.4%) engaged in the program. Compared to women who did not engage, women who engaged were more likely to intend breastfeeding [168 (95%) vs 47 (87%), p=0.046] and to continue breastfeeding at the postpartum visit [92 (74%) vs 20 (53%), p=0.012]. These associations persisted after controlling for potential confounders (Table) and were not mediated by improvements or remission in depressive symptoms. While antenatal mental health disorders are a risk factor for lack of intention or early cessation of breastfeeding, engagement in a collaborative care program is associated with improvement in both breastfeeding intention and continuation, independent of the mental health benefits.